直覺手術 (ISRG) 2024 Q2 法說會逐字稿

Thank you, everyone, for standing by, and welcome to the Intuitive second-quarter 2024 earnings release. (Operator Instructions) As a reminder, today's call is being recorded. I will now turn the call over to your host, Head of Investor Relations, Brian King. Please go ahead.

感謝各位的耐心等待，歡迎收看 Intuitive 2024 年第二季財報發表會。（操作員說明）提醒您，今天的通話將會被錄音。現在我將把電話交給主持人、投資人關係主管布萊恩金。請繼續。

Good afternoon, and welcome to Intuitive second-quarter earnings conference call. With me today, we have Gary Guthart, our CEO; Dave Rosa, our President; and Jamie Samath, our CFO.

下午好，歡迎參加 Intuitive 第二季財報電話會議。今天和我在一起的有：我們的執行長 Gary Guthart；我們的總裁 Dave Rosa；以及我們的財務長 Jamie Samath。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K for the fiscal year ended December 31, 2023, and subsequent filings.

在開始之前，我想告知各位，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於存在某些風險和不確定性，實際結果可能與明示或暗示的結果有重大差異。這些風險和不確定性已在我們的證券交易委員會文件中進行了詳細描述，包括我們最新的截至 2023 年 12 月 31 日的財政年度的 10-K 表格以及後續文件。

Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements. Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events Section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website.

您可以透過我們的網站或美國證券交易委員會的網站找到我們向該委員會提交的文件。投資者應注意，不要過度依賴此類前瞻性陳述。請注意，本次電話會議的音訊回放將在我們網站intuitive.com的「投資者關係」頁面下的「活動」欄位中提供。今天的新聞稿和補充財務數據表已發佈在我們的網站上。

Today's format will consist of providing you with highlights of our second quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will introduce the call and provide an organization update. Dave will present the quarter's business and operational highlights. Jamie will provide a review of our financial results. Then I will discuss procedure and clinical highlights and provide our updated financial outlook for 2024. And finally, we will host a question-and-answer session. With that, I will turn it over to Gary.

今天的會議形式將包括：首先向您介紹我們今天早些時候發布的新聞稿中所述的第二季度業績亮點，然後進行問答環節。Gary 將主持會議並提供組織最新情況介紹。Dave 將介紹本季的業務和營運亮點。Jamie將對我們的財務表現進行評估。然後我將討論流程和臨床亮點，並提供我們最新的 2024 年財務展望。最後，我們將舉行問答環節。接下來，我將把麥克風交給蓋瑞。

Thank you for joining us today. The fundamentals of our business were healthy in the quarter with solid procedure growth and strong capital placements, resulting in healthy financial performance. In the quarter, we made good progress with all three of our system platforms, including taking our measured rollout of da Vinci 5 to our next phase, continuing to stabilize and supply and support of customer expansion and expanding da Vinci SP installs in Europe, while supporting SP procedure growth across regions. Some multi-port procedural headwinds continued from last quarter, and we will describe these later on the call.

感謝您今天蒞臨。本季公司業務基本面良好，業務流程穩定成長，資本配置強勁，實現了良好的財務表現。本季度，我們在所有三個系統平台方面都取得了良好進展，包括將達文西 5 的穩步推廣推進到下一階段，繼續穩定供應並支援客戶擴張，並在歐洲擴大達文西 SP 的安裝，同時支援各地區的 SP 手術成長。自上個季度以來，多端口程序方面存在一些不利因素，我們將在稍後的電話會議上對此進行描述。

Before turning the time over to Dave, I'd like to thank Marshall Mohr, our prior CFO and outgoing Head of Global Business Services. Marshall will be taking his skills to pursuits outside of Intuitive in September this year as he approaches his next endeavor. I thank him on behalf of all of us for his outstanding stewardship at Intuitive for the past 18 years.

在把時間交給戴夫之前，我想感謝我們之前的財務長兼即將卸任的全球業務服務主管馬歇爾·莫爾。今年九月，馬歇爾將把他的技能運用到 Intuitive 以外的領域，開啟他的下一個旅程。我謹代表我們所有人感謝他在過去 18 年裡對 Intuitive 的出色領導。

We are pleased to announce that in addition to his role as CFO, Jamie will expand his responsibilities to leading our information technology and global facilities teams. I'll now turn the time over to Dave, who will take you through commercial and operational highlights in greater detail.

我們很高興地宣布，除了擔任財務長之外，Jamie 還將擴大其職責範圍，領導我們的資訊技術和全球設施團隊。現在我將把時間交給戴夫，他將更詳細地為大家介紹商業和營運方面的亮點。

Thank you, Gary. Starting with procedures, we experienced solid growth in the quarter of nearly 17% compared with a strong Q2 2023, which reflected the return of patients post pandemic, cholecystectomy, colon resection, lung resection and foregut procedures led to global procedure growth. General surgery led US procedure growth in the second quarter, and outside the US, procedure growth was led by non urology procedures.

謝謝你，加里。從手術量來看，本季度實現了近 17% 的穩健增長，與 2023 年第二季度強勁的增長相比，這反映了疫情後患者的回歸，膽囊切除術、結腸切除術、肺切除術和上消化道手術帶動了全球手術量的增長。第二季度，美國普通外科手術引領了手術量的成長；而在美國以外，非泌尿科手術引領了手術量的成長。

Regional performance included strength in Europe led by Germany, the UK, and Italy. And in Asia, we have mixed market conditions, largely consistent with Q1. Brian will describe these dynamics later in the call Turning to capital, we placed 341 da Vinci systems in the quarter, of which 320 were multiport systems, including 70 da Vinci 5 system. Our teams installed 21 SP systems and 74 Ion systems in the quarter with solid capital placements in the US, Japan and India and pressure in Europe and China.

區域表現方面，歐洲表現強勁，其中德國、英國和義大利表現特別突出。亞洲市場狀況喜憂參半，與第一季的情況基本一致。Brian 將在電話會議的稍後部分描述這些動態。說到資金方面，我們本季投放了 341 台達文西手術系統，其中 320 台是多埠系統，包括 70 台達文西 5 系統。本季度，我們的團隊在美國、日本和印度安裝了 21 套 SP 系統和 74 套 Ion 系統，並在美國、日本和印度獲得了穩健的資金投入，同時在歐洲和中國也獲得了壓力。

System utilization defined as procedures per installed clinical system per quarter grew 2% globally year over year for our multi-port platforms, lower than our historical trend, reflecting procedure strength a year ago due to patient backlog. Utilization for SP and Ion continue to grow in the double-digit range in the quarter.

系統利用率（定義為每季度每個已安裝臨床系統的手術量）在全球範圍內同比增長 2%，低於我們歷史趨勢，這反映了去年由於患者積壓而導致的手術量增長。本季 SP 和 Ion 的利用率持續以兩位數的速度成長。

Turning to our finances, revenue growth of 14% in the quarter reflects solid procedure performance and strong capital placements. Product margins were above our expectations, reflecting a combination of cost reductions, fixed overhead leverage, and some one-time nonrecurring benefits. Operating expenses reflected planned leverage in our enabling functions. Jamie will take you through our finances in greater detail later in the call.

從財務狀況來看，本季營收成長 14%，反映了穩健的業務表現和強勁的資本投入。產品利潤率高於我們的預期，這反映了成本降低、固定管理費用槓桿作用以及一些一次性非經常性收益的綜合影響。營運費用反映了我們在各項職能部門中所規劃的槓桿作用。稍後在通話中，Jamie會更詳細地向您介紹我們的財務狀況。

In Q2, we moved into the next phase of our rollout of da Vinci 5. Within the quarter, we placed 70 da Vinci 5 systems as the launch continues to progress in line with our plans. Customer feedback points to improvements in precision imaging, ergonomics, and integration, the combination of which customers indicate has way to overall efficiency improvements.

第二季度，我們進入了達文西5號手術系統推廣的下一個階段。本季度，我們安裝了 70 套達文西 5 系統，發布工作正按計畫順利進行。客戶回饋表明，成像精度、人體工學和整合性均有所提高，客戶表示，這些方面的結合能夠顯著提高整體效率。

Both force feedback and case insights bring new capabilities and analytics to surgery. We are encouraged by early insights these capabilities are presenting and are working hard to improve production and supply for force feedback, instruments and smooth our computational pipelines and workflows for case insights. We expect these capabilities to be powerful and the maturity and evidence of impact to build over coming quarters.

力回饋和病例分析都為外科手術帶來了新的能力和分析方法。我們對目前這些功能所展現的初步成果感到鼓舞，並正在努力改進力回饋儀器的生產和供應，以及簡化我們的計算流程和工作流程，以獲得更深入的案例分析。我們預計這些能力將非常強大，並且在未來幾季中，其成熟度和影響力將持續增強。

We launch new products thoughtfully, centered around outstanding customer experiences as our customers pursue operational and clinical excellence. We continue monitoring several key metrics across our measured rollout of da Vinci 5 as we ramp our supply and respond to customer input. We expect our measured rollout to continue through the first half of 2025.

我們精心推出新產品，以卓越的客戶體驗為中心，協助客戶追求卓越的營運和臨床水準。在我們逐步擴大達文西 5 手術系統供應並回應客戶回饋的過程中，我們將繼續監控幾個關鍵指標。我們預計這種循序漸進的推廣方式將持續到 2025 年上半年。

Adoption of our digital products and services grew nicely in the quarter with routine use of My Intuitive app, expanding to nearly 14,000 surgeons and surgeons using Intuitive more than doubling versus a year ago. The long-term opportunity for computational tools is both significant and difficult. To recognize these benefits at scale requires a foundational infrastructure that includes robust curated data, secure data warehousing, and global privacy compliance.

本季度，我們的數位產品和服務的使用率穩步增長，My Intuitive 應用的常規使用量已擴大到近 14,000 名外科醫生，使用 Intuitive 的外科醫生人數比一年前增加了一倍多。計算工具的長期發展機會既巨大又充滿挑戰。要大規模地實現這些益處，需要一個基礎架構，包括強大的精選資料、安全的資料倉儲和全球隱私合規性。

Our digital ecosystem, including case insights, leverages this infrastructure and enables us to collaborate with customers on a global scale to identify meaningful insights. These insights enable customers to optimize their robotic programs and ultimately reduce time to proficiency and improve clinical outcomes. As we said before, validations take time and are worthy pursuit.

我們的數位生態系統（包括案例洞察）利用了這個基礎設施，使我們能夠與全球客戶合作，從而發現有意義的見解。這些見解能夠幫助客戶優化其機器人程序，最終縮短達到熟練程度所需的時間並改善臨床結果。正如我們之前所說，驗證需要時間，而且是值得追求的。

Turning to Ion, our teams have made material progress resolving supply constraints on catheters and vision probes. Excellence in manufacturing at scale in this space is complex, and we continue to reinforce our capabilities. Our commercialization in Europe continues according to plan, and our teams are progressing towards commercialization in China.

轉向 Ion 公司，我們的團隊在解決導管和視覺探針的供應限制方面取得了實質進展。在這個領域實現規模化卓越製造是一項複雜的工作，我們將持續加強自身能力。我們在歐洲的商業化進程正按計畫進行，我們的團隊也正在推動在中國的商業化進程。

Turning to SP, last week, we received FDA clearance for thoracic procedures. We will be measured in our thoracic indication launch as we work to build a robust training and proctoring network as well as bring stapling to our SP platform. In closing, we are committed to our 2024 priorities, supporting our measured launch of da Vinci 5 and our other new platforms by region, supporting surgeons' adoption of focused procedures, continuing to improve product quality and margins, and finally, improving productivity in those functions that benefit from global scale. I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

再來談談SP，上週我們獲得了FDA對胸腔外科手術的批准。我們將努力建立強大的培訓和指導網絡，並將縫合技術引入我們的 SP 平台，以衡量我們在胸腔外科適應症推廣方面的進展。最後，我們將繼續致力於實現 2024 年的優先事項，支持我們按地區穩步推出達文西 5 和其他新平台，支持外科醫生採用重點手術，繼續提高產品品質和利潤率，並最終提高那些受益於全球規模的職能部門的生產力。現在我將時間交給傑米，他將更詳細地向大家介紹我們的財務狀況。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis and will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website.

午安.我將在準備好的發言稿中，首先介紹我們按非GAAP或準備基準所取得的績效亮點，然後總結我們按GAAP基準所取得的績效。我們已在網站上公佈了模擬財務報表與GAAP財務報表之間的調節表。

Q2 da Vinci procedures grew 17%. The installed base of systems grew 14% to just over 9,200 systems and average system utilization increased by 2%, lower than long-term historical averages, reflecting procedure strength in Q2 last year as a result of patient backlog. US procedures grew 14%, driven by growth in general surgery. Bariatric procedures in the US declined in the mid-single digit range. US procedures grew 22%, reflecting strong growth in general surgery, gynecology, and thoracic procedures.

第二季達文西程式成長了 17%。系統安裝基數成長了 14%，達到 9,200 多套系統，平均係統利用率成長了 2%，低於長期歷史平均水平，這反映出去年第二季度由於患者積壓，手術量有所增加。美國手術量增加了 14%，主要由普通外科手術的成長推動。美國減肥手術數量下降了中等個位數百分比。美國手術量成長了 22%，反映出一般外科、婦科和胸腔外科手術的強勁成長。

With respect to capital performance, we placed 341 systems in the second quarter compared to 331 systems in Q2 of last year. In the US, we placed 149 systems in Q2 compared to 157 systems placed last year, reflecting in part lower trade-ins. US system placements in Q2 included 70 da Vinci 5 placements.

就資本績效而言，我們第二季安裝了 341 套系統，而去年第二季為 331 套。在美國，我們在第二季安裝了 149 套系統，而去年同期安裝了 157 套系統，部分原因是舊機置換數量減少。第二季美國系統植入量包括 70 例達文西 5 手術植入。

Given the planned hardware and software updates of da Vinci 5 in the second half of this year and continued focus on maturing manufacturing and expanding capacity, we expect the da Vinci 5 placements will be constrained through the first half of 2025. Outside the US, we placed 192 systems in quarter two compared with 174 systems last year.

鑑於達文西 5 手術系統計劃在今年下半年進行硬體和軟體更新，並持續致力於完善製造流程和擴大產能，我們預計達文西 5 手術系統的安裝量在 2025 年上半年將受到限制。在美國以外，我們第二季安裝了 192 套系統，而去年同期為 174 套。

Current quarter system placements included 71 into Europe, 41 into Japan, and 14 into China compared with 76 into Europe, 33 into Japan, and 16 into China in Q2 of last year. We also saw relatively strong placements in India as well as markets served by our distributors, including Australia.

本季系統部署情況包括歐洲 71 台、日本 41 台及中國 14 台，而去年第二季則分別為歐洲 76 台、日本 33 台及中國 16 台。我們也看到，在印度以及我們的經銷商所服務的市場（包括澳洲）的市佔率相對較強。

Placements in Europe reflect health system budget constraints as several European governments are resetting capital spending post pandemic. Second quarter revenue was $2 billion, an increase of 14% from last year. On a constant currency basis, revenue growth was 15%.

歐洲的醫療資源分配反映了醫療系統預算的限制，因為許多歐洲國家政府正在疫情後調整資本支出。第二季營收為20億美元，比去年同期成長14%。以固定匯率計算，營收成長了15%。

Additional revenue statistics and trends are as follows. Leasing represented 51% of Q2 placements, relatively consistent with recent trends. However, given customer preference for our usage-based models in the US and the launch of da Vinci 5, we continue to expect the proportion of systems placed under lease arrangements to grow over time.

其他收入統計數據和趨勢如下。第二季租賃佔總投放量的 51%，與近期趨勢基本一致。然而，鑑於美國客戶更傾向於我們按使用量計費的模式，以及達文西 5 的推出，我們仍然預計隨著時間的推移，以租賃方式安排的系統比例將會成長。

Q2 system average selling prices were $1.44 million as compared to $1.39 million last year. Higher year-over-year system ASPs reflected a higher mix of da Vinci 5 and lower trade-ins, partially offset by a higher mix of system placements in Japan with a weaker yen exchange rate and lower pricing in China.

第二季系統平均售價為 144 萬美元，去年同期為 139 萬美元。系統平均售價較去年同期上漲，反映出達文西 5 手術系統佔比上升和以舊換新手術量下降，但部分被日圓匯率走弱導致的日本系統安裝量上升以及中國系統定價下降所抵消。

In Q2 of 2023, trade-ins represented 18% of total system placements as compared to 6% in Q2 of 2024. We recognized $28 million of lease buyout revenue in Q2 compared with $29 million last quarter and $12 million last year. Da Vinci instrument and accessory revenue per procedure was approximately $1,800, an increase of approximately $20 compared to last quarter.

2023 年第二季度，以舊換新佔系統總安裝量的 18%，而 2024 年第二季度這一比例為 6%。第二季我們確認了 2,800 萬美元的租賃買斷收入，而上一季為 2,900 萬美元，去年同期為 1,200 萬美元。達文西手術器械及配件的單次手術收入約為 1800 美元，比上一季增加了約 20 美元。

The sequential increase in I&A per procedure is primarily a result of customer ordering patterns in the US Turning to our Ion platform, procedures grew 82% to approximately 23,200 procedures in the second quarter. During the quarter, we placed 74 Ion Systems compared to 59 last year and 70 last quarter.

每例手術的 I&A 數量逐年增加，主要是因為美國客戶的訂購模式。轉向我們的 Ion 平台後，第二季手術量增加了 82%，達到約 23,200 例。本季我們共投放了 74 家 Ion Systems 公司，去年同期為 59 家，上季為 70 家。

During Q2, we caught up with the remaining backlog of system placements as supply of catheters and vision probes continued to improve. The installed base of Ion Systems increased 56% year over year to 678 systems, of which 275 are under operating lease arrangements.

第二季度，隨著導管和視覺探頭的供應持續改善，我們完成了剩餘的系統植入積壓工作。Ion Systems 的裝置量年增 56%，達到 678 套系統，其中 275 套為經營租賃系統。

Second quarter SP procedure growth accelerated to 74% with strong growth in Korea and the US and early-stage growth in Japan in Europe. 21 of the systems placed in the quarter were SP systems, including 10 systems placed in Europe. The SP installed base grew 56% from the year ago quarter to 222 systems.

第二季SP手術量成長加速至74%，其中韓國和美國市場成長強勁，日本和歐洲市場也處於早期成長階段。本季共植入21套系統，皆為SP系統，其中10套植入歐洲。SP 安裝基數比去年同期成長了 56%，達到 222 套系統。

Moving on to the rest of the P&L, Pro forma gross margin for the second quarter of 2024 was ahead of our expectations at 70% compared with 68.5% for the second quarter of 2023 and 67.6% last quarter. Second quarter pro forma gross margin reflected certain one-time benefits that we do not expect to recur. Excluding these onetime benefits, pro forma gross margin would have been 69.5%.

接下來來看損益表的其他部分，2024 年第二季的備考毛利率為 70%，高於我們的預期，而 2023 年第二季為 68.5%，上一季為 67.6%。第二季備考毛利率反映了某些我們預計不會再次發生的一次性收益。除去這些一次性收益，以備考計算的毛利率為 69.5%。

The sequential improvement in pro forma gross margin primarily reflects lower inventory reserves, cost reductions in certain purchase components, lower freight rates, and leverage of fixed overhead. In accordance with our plans, product margins for our Ion and SP platforms improved in the quarter and will remain a focus for our business unit and manufacturing teams over the medium term. As a reminder, given recent and ongoing capital investments, we expect increased depreciation expense in the second half and a significant increase in depreciation expense starting in Q1 of 2025.

預計毛利率的環比改善主要反映了庫存儲備減少、某些採購項目的成本降低、運費降低以及固定間接費用的槓桿作用。根據我們的計劃，本季 Ion 和 SP 平台的產品利潤率有所提高，並將繼續成為我們業務部門和製造團隊在中期內的重點。提醒各位，鑑於近期和持續的資本投資，我們預計下半年折舊費用將增加，並且從 2025 年第一季開始，折舊費用將大幅增加。

Second quarter pro forma operating expenses increased 11% compared with last year, reflecting the ongoing benefit of planned leverage in enabling functions. We continue to prioritize investments in R&D to fund innovation and future growth.

第二季備考營運費用較去年同期成長 11%，反映出計畫槓桿作用在賦能職能方面持續發揮作用。我們將繼續優先投資研發，為創新和未來成長提供資金。

During the quarter, we added approximately 550 employees, of which roughly half were in our manufacturing operations to support growth in customer demand. Pro forma other income was $79.4 million for Q2, higher than $72.5 million in the prior quarter, primarily due to higher interest income.

本季我們新增了約 550 名員工，其中約一半在我們的製造部門工作，以支援客戶需求的成長。第二季其他收入以備考計算為 7,940 萬美元，高於上一季的 7,250 萬美元，主要原因是利息收入增加。

Our pro forma effective tax rate for the second quarter was 22.5%, consistent with our expectations. Second quarter 2024 pro forma net income was $641 million or $1.78 per share compared with $507 million or $1.42 per share for the second quarter of last year.

第二季的預期實際稅率為 22.5%，與我們的預期一致。2024 年第二季備考淨收入為 6.41 億美元，即每股 1.78 美元，去年同期為 5.07 億美元，即每股 1.42 美元。

I will now summarize our GAAP results. GAAP net income was $527 million or $1.46 per share for the second quarter of 2024 compared with GAAP net income of $421 million or $1.18 per share for the second quarter of 2023. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee equity plans, employee stock-based compensation, amortization of intangibles, litigation charges and gains and losses on strategic investments.

現在我將總結一下我們的GAAP業績。2024 年第二季 GAAP 淨收入為 5.27 億美元，即每股 1.46 美元，而 2023 年第二季 GAAP 淨收入為 4.21 億美元，即每股 1.18 美元。網站上列出了備考淨收入與 GAAP 淨收入之間的調整，並進行了量化，其中包括與員工股權計劃、員工股票薪酬、無形資產攤銷、訴訟費用以及戰略投資的損益相關的超額稅收優惠。

We ended the year with cash and invest -- we ended the quarter with cash and investments of $7.7 billion, higher than the $7.3 billion we ended last quarter. The sequential increase in cash and investments reflected cash generated from operating activities, partially offset by capital expenditures of $309 million. And with that, I would like to turn it over to Brian.

我們年底的現金和投資餘額為 77 億美元，高於上一季末的 73 億美元。現金和投資的環比增長反映了經營活動產生的現金，但部分被 3.09 億美元的資本支出所抵消。接下來，我將把發言權交給布萊恩。

Thank you, Jamie. Overall, second quarter procedure growth was 17% compared to 22% for the second quarter of 2023 and 16% last quarter. In the US, second-quarter 2024 procedure growth was 14% compared to 19% for the second quarter of 2023 and 14% last quarter.

謝謝你，傑米。總體而言，第二季度手術量增加了 17%，而 2023 年第二季為 22%，上一季為 16%。在美國，2024 年第二季手術量成長了 14%，而 2023 年第二季成長了 19%，上一季成長了 14%。

Second quarter growth was led by procedures within general surgery with strength in cholecystectomy and foregut procedures and also thoracic procedures. Bariatric procedure growth declined in the mid-single digit range.

第二季成長主要由一般外科手術帶動，其中膽囊切除術、上消化道手術和胸腔外科手術表現強勁。減重手術數量的成長率下降至個位數中段。

Outside of the US second-quarter procedure volume grew 22% compared with 28% for the second quarter of 2023 and 20% last quarter. Growth was led by non-urology procedures with strength in colon resection, hysterectomy, and lung resection procedures.

美國以外地區第二季手術量增加了 22%，而 2023 年第二季成長了 28%，上一季成長了 20%。成長主要由非泌尿外科手術帶動，其中結腸切除術、子宮切除術和肺切除術表現強勁。

In Europe, second-quarter growth continued to be led by procedures beyond urology, primarily from general surgery and gynecology procedure categories. Germany, the UK, and Italy procedure performance led the region with each experiencing strong growth in colon and rectal resection, hysterectomy and other general surgery procedures.

在歐洲，第二季的成長繼續由泌尿外科以外的手術引領，主要來自普通外科和婦科手術類別。德國、英國和義大利的手術表現領先於該地區，這三個國家在結腸和直腸切除術、子宮切除術和其他普通外科手術方面均實現了強勁增長。

In Asia, growth in the second quarter was led by Japan and India, while growth in China was stressed and Korea procedure growth continued to be impacted by physician strikes. In Japan, overall procedure growth was solid, with continued strength in colon and rectal resection, gynecology, and lung resection procedures.

在亞洲，第二季的成長主要由日本和印度引領，而中國的成長則面臨壓力，韓國的手術量成長持續受到醫生罷工的影響。在日本，整體手術量成長穩健，結腸直腸切除術、婦科手術和肺切除術等手術量持續保持強勁成長。

In India, while still in the early stage of adoption, we saw strength in gynecology and general surgery procedures, particularly with growth in hysterectomy, cholecystectomy, and hernia repair. China procedure growth was lower than prior period averages when compared to the same quarter a year ago, which experienced a recovery in procedures impacted by COVID. System utilization remained strong, while capital placements continued to be impacted by delayed tenders and emerging domestic robotic systems.

在印度，雖然仍處於早期採用階段，但我們看到婦科和普通外科手術方面表現強勁，特別是子宮切除術、膽囊切除術和疝氣修補術的增長。與去年同期相比，中國手術量成長低於前期平均水平，而去年同期受新冠疫情影響的手術量有所回升。系統利用率保持強勁，但資本配置繼續受到招標延遲和新興國內機器人系統的影響。

Now, turning to the clinical side of our business. Each quarter on these calls, we highlight certain recently published studies that we deem to be notable, however, to gain a more complete understanding of the body of evidence, we encourage all stakeholders to thoroughly review the extensive detail of scientific studies that have been published over the years.

現在，讓我們來看看我們業務的臨床方面。每季度，我們都會在這些電話會議上重點介紹一些我們認為值得關注的近期發表的研究，但是，為了更全面地了解證據體系，我們鼓勵所有利益相關者徹底審查多年來發表的大量科學研究的細節。

Earlier this year, Dr. Jiang and team from the Guangzhou university of Chinese Medicine published a systematic review and meta-analysis in the International Journal of Surgery that looked at open, laparoscopic, and robotic-assisted surgery approaches to rectal cancer management. This meta-analysis covered 56 studies and included over 25,000 patients, of which approximately 11,000 patients received robotic-assisted surgery over 13,000 patients laparoscopic surgery and over 390 patients received open surgery.

今年早些時候，廣州中醫藥大學的江博士及其團隊在《國際外科雜誌》上發表了一篇系統性回顧和統合分析，探討了直腸癌治療的開放式手術、腹腔鏡手術和機器人輔助手術方法。這項統合分析涵蓋了 56 項研究，包括超過 25,000 名患者，其中約 11,000 名患者接受了機器人輔助手術，超過 13,000 名患者接受了腹腔鏡手術，超過 390 名患者接受了開放性手術。

When compared to the control group of both laparoscopic and open procedures, patients undergoing a robotic-assisted approach had an approximately two days shorter length of stay. Specifically when compared to lap, the robotic-assisted group was associated with a 1.7-day shorter length of stay.

與接受腹腔鏡手術和開放性手術的對照組相比，接受機器人輔助手術的患者住院時間縮短了約兩天。具體來說，與腹腔鏡手術相比，機器人輔助手術組的住院時間縮短了 1.7 天。

Relative to open surgery, the length of stay was 5.5 days shorter. The robotic-assisted approach was also demonstrated a protective effect for converting to an open procedure with 61% lower odds of conversion associated with robotics relative to the laparoscopic approach.

與開放性手術相比，住院時間縮短了 5.5 天。機器人輔助手術也被證明具有保護作用，可降低轉為開放性手術的幾率，與腹腔鏡手術相比，機器人輔助手術的轉為開放性手術的幾率降低了 61%。

Finally, when compared to the laparoscopic and open control group, the robotic assisted approach showed less estimated blood loss, approximately 40% lower odds of urinary retention, and when compared to open a higher number of harvested lymph nodes. The authors concluded quote, the robotic approach emerges as the most favorable option for managing rectal cancer when compared to open laparoscopic and transitional techniques as it delivers the finest blend of oncological, functional, and patient recovery outcomes.

最後，與腹腔鏡和開放式對照組相比，機器人輔助手術估計出血量較少，尿瀦留的幾率降低了約 40%，與開放式手術相比，切除的淋巴結數量更多。作者總結道：“與開放式腹腔鏡手術和過渡性手術相比，機器人手術是治療直腸癌的最佳選擇，因為它能帶來腫瘤治療、功能恢復和患者康復的最佳平衡。”

The digital interface of surgical robots enables a shift in the paradigm of surgical training, facilitating shorter learning curves that are more comprehensive and notably reducing the morbidity and mortality associated with them, end quote.

手術機器人的數位化介面改變了外科手術培訓的範式，縮短了學習曲線，使其更加全面，並顯著降低了與手術相關的發病率和死亡率。

I will now turn to our financial outlook for 2024. Starting with procedures. On our last call, we forecasted full-year 2024 procedure growth within a range of 14% and 17%. We are now narrowing our forecast and expect full year 2024 procedure growth of 15.5% to 17%. The low end of the range assumes further softening in bariatric procedures, along with increasing headwinds in Asia from prolonged physician strikes in Korea and in China from delayed tenders and emerging domestic robotic systems impacting capital placements and therefore, procedure growth.

接下來，我將談談我們對2024年的財務展望。首先從流程入手。在上一次電話會議上，我們預測 2024 年全年手術量成長率將在 14% 到 17% 之間。我們現在縮小了預測範圍，預計 2024 年全年手術量將增加 15.5% 至 17%。該範圍的下限假設減重手術進一步疲軟，同時亞洲地區也面臨越來越大的不利因素，例如韓國醫生長期罷工、中國招標延遲以及新興的國內機器人系統影響資本配置，從而影響手術成長。

At the high end of the range, we assume bariatrics stabilizes at current quarter rates and headwinds in Korea and China do not get worse. Turning to gross profit, we are increasing our pro forma gross profit margin to be within 68.5% and 69% of net revenue. Our actual gross profit margin will vary quarter to quarter, depending largely on product, regional and trade-in mix, and the impact of new product introductions.

在範圍的高端，我們假設減重手術數量穩定在目前的季度水平，並且韓國和中國的不利因素不會惡化。就毛利而言，我們將預期毛利率提高到淨收入的 68.5% 至 69%。我們的實質毛利率會因季度而異，主要取決於產品、地區和以舊換新組合，以及新產品推出的影響。

Turning to operating expenses, we are lowering our guidance for pro forma operating expense growth to be between 10% and 13%. We are refining our non-cash stock compensation expense to range between $680 million to $700 million in 2024. We are narrowing our guidance for other income, which is comprised mostly of interest income to total between $300 million and $320 million in 2024.

關於營運費用，我們將備考營運費用成長預期下調至 10% 至 13%。我們正在調整非現金股票補償支出，預計到 2024 年，支出將在 6.8 億美元至 7 億美元之間。我們將其他收入（主要包括利息收入）的預期範圍縮小至 2024 年總額在 3 億美元至 3.2 億美元之間。

With regard to capital expenditures, we continue to estimate a range of $1 billion to $1.2 billion, primarily for planned facility construction activities. With regard to income tax, there is no change to our guidance of 2024 pro forma income tax rate to be between 22% and 24% of pretax income. That concludes our prepared comments. We will now open the call to your questions.

關於資本支出，我們繼續估計在 10 億美元至 12 億美元之間，主要用於計劃中的設施建設活動。關於所得稅，我們2024年的預期所得稅稅率仍為稅前所得的22%至24%，這項預期沒有改變。我們的發言到此結束。現在開始回答各位的問題。

(Operator Instructions) Larry Biegelsen, Wells Fargo.

（操作說明）拉里·比格爾森，富國銀行。

Good afternoon. Thanks for taking the question and congratulations on a really nice quarter here. Of course, I have to start with the da Vinci 5, really strong start here, 70 placements. I heard the comments about being constrained through the second half of 2025, but da Vinci 5 was almost half of the US placements. So it looks like a strong launch.

午安.感謝您回答這個問題，也恭喜您本季業績斐然。當然，我得先說說達文西5，它開局非常強勁，取得了70分的好成績。我聽說了 2025 年下半年供應受限的說法，但達文西 5 在美國的銷售量幾乎佔了一半。看來這是一次強勁的發布。

So how should we think about the ramp in da Vinci 5 placements in the second half? And how should we think about trade-ins going forward, which are probably a little lower than I expected this quarter in the US. And I had one follow-up.

那我們該如何看待達文西5在下半場的版面調整呢？那我們該如何看待未來的以舊換新情況呢？本季美國的以舊換新數量可能比我預期的要少一些。我還有一個後續問題。

Hey, Larry, this is Jamie. I would say, for the second half of '24, you should expect DV5 placements in the US to increase modestly quarter to quarter and that in part reflects the fact that we do have this hardware-software update that we described. And so you have to organize how you do that build plan through the factory carefully for that update.

嘿，拉里，我是傑米。我認為，在 2024 年下半年，DV5 在美國的出貨量應該會逐季小幅增長，這在一定程度上反映了我們確實進行了我們所描述的硬體軟體更新。因此，你必須仔細安排如何透過工廠來執行該更新的生產計劃。

And we said we'd be in a measured rollout through the first half of 2025. With respect to how we've organized the measured rollout of DV. five, we've really focused the sales force on looking to place da Vinci 5 for incremental capacity for our customers versus the trade-in cycle. I think we'd rather get to a broad launch where we essentially have unconstrained supply relative to demand before we look at the trade-in cycle.

我們說過，我們將在 2025 年上半年穩步推出這項服務。關於我們如何組織達文西5的穩定推廣，我們真正讓銷售團隊專注於為我們的客戶尋找增加產能的達文西5，而不是以舊換新。我認為我們寧願先進行大規模的推廣，使供應相對於需求基本上不受限制，然後再考慮以舊換新周期。

Just a couple of comments on the trade-in cycle, I think I wouldn't expect a trade-in cycle to suddenly emerge and take off quickly. I think what we've seen in the past is that that's progressive and over multiples of years. And in part that will reflect the fact, many customers will want to evaluate da Vinci 5. They'll want to see evidence grow over time in terms of its capability and feature set. And of course, on their desire for da Vinci 5 will depend on their individual program and what they see the value of that in part given the higher pricing or lease costs for da Vinci 5.

關於以舊換新周期，我只想說幾點：我認為以舊換新周期不會突然出現並迅速發展起來。我認為我們過去看到的是，這是一個漸進的過程，而且需要數年時間。部分原因在於，許多客戶都希望評估達文西5。他們會希望看到隨著時間的推移，其性能和功能集的證據不斷增強。當然，他們是否想要達文西 5 取決於他們各自的治療方案以及他們認為達文西 5 的價值，部分原因在於達文西 5 的定價或租賃成本較高。

That's very helpful. And then I wanted to ask about China. You mentioned that a couple of times on the call today. We recently saw a new stimulus announced there. And my question is -- and you've talked about the anti-corruption initiative. Is that still having an impact? And how are you guys thinking about the new stimulus that was announced that will help drive placements. Thanks for taking the question.

那很有幫助。然後我想問關於中國的問題。你今天在電話會議上提到過幾次這一點。我們最近看到那裡宣布了一項新的經濟刺激計劃。我的問題是──您也談到了反腐敗倡議。這種影響現在仍然存在嗎？你們對新宣布的、旨在促進就業安置的刺激計劃有什麼看法？感謝您回答這個問題。

And Larry, it's Dave. Answering the second part of your question, first around the stimulus. In talking to our teams, we don't see that it's going to have a material impact on the placements of systems or an impact on the quota.

拉里，我是戴夫。回答你問題的第二部分，先圍繞刺激材料展開討論。與我們的團隊溝通後，我們認為這不會對系統部署或配額產生實質影響。

With respect to the operating environment of China, the anti-corruption that you referenced, there's no question that the operating environment remains challenging. The health system in China is rebasing around the economics in medtech. I think that's clear across the industry.

關於中國的經營環境，以及你提到的反貪腐問題，毫無疑問，中國的經營環境仍充滿挑戰。中國的醫療體係正在圍繞醫療技術經濟進行重組。我認為這一點在整個行業中都很明確。

On the placement side, customers are continuing to value our offerings clearly. And we are seeing, as you know, the emergence of domestic systems. And so in spite of those challenges and everything that's going on in the environment in China, we're still seeing double-digit growth in procedures. So we remain confident and look forward to continuing our investments and focus on China.

在市場定位方面，客戶仍然非常重視我們的產品和服務。正如你們所知，我們正在看到國內制度的出現。因此，儘管面臨這些挑戰以及中國當前環境的各種變化，我們仍然看到手術量實現了兩位數的成長。因此，我們依然充滿信心，並期待繼續在中國進行投資和重點發展。

Thanks for taking the questions, guys.

謝謝各位回答問題。

Travis Steed, Bank of America.

特拉維斯·斯蒂德，美國銀行。

Congrats on the good quarter. Wanted to maybe if there's any way you can help us understand the demand side of the DV5 equation. I know we're in a constrained rollout, but 47% of the placements in the US were DV5 this quarter.

恭喜你們本季業績出色。想請教一下，能否幫助我們理解 DV5 方程式的需求面？我知道我們目前處於受限推廣階段，但本季美國 47% 的安裝量為 DV5。

And then are there any way to rank order some of the factors you need to mark off and check off the list to get the full launch. Heard the software-hardware upgrade, but I assume there's some other variables to consider as well.

那麼，有沒有辦法對需要逐一勾選並完成的因素進行排序，才能最終實現全面發布呢？聽說要進行軟硬體升級，但我認為還有其他一些因素需要考慮。

Yeah, hey, Travis. It's Dave. Again, it's a couple of the factors that we've discussed in the past. And it's really three primary areas. One is making sure that we are maturing our supply chain and our manufacturing capacity so that we're again able to get to the quality, to the cost of the yields that we expect as we approach a broad launch.

嘿，崔維斯。是戴夫。這又是我們過去討論過的幾個因素之一。實際上它主要包含三個方面。一方面，我們要確保我們的供應鏈和生產能力不斷成熟，以便我們能夠再次達到預期的品質、成本和產量，從而在大規模上市之際實現目標。

The second part is what Jamie described around the software and hardware update where we're trying to get that integrated into our systems and balancing the factory output. And then the third thing is listening to our customers. And so as these placements happen, we're listening to our customers and responding to their feedback. And we'll be releasing some software updates along the way here in order to respond to that feedback. And so we want to get that in place before we get to broad launch.

第二部分是 Jamie 所描述的關於軟體和硬體更新的內容，我們正在努力將其整合到我們的系統中，並平衡工廠的產量。第三點是傾聽客戶的意見。因此，在進行這些部署時，我們會傾聽客戶的意見並回應他們的回饋。我們將在此過程中發布一些軟體更新，以回應這些回饋。所以我們希望在全面發布之前把這些都落實到位。

Perhaps I would just add, your question -- part of your question is on the demand side. And I would say that in the early phase of a launch, you have a tendency to see early adopters look for the latest technology and all the -- also the larger institutions, the large IDNs. And so you have to give it some time to see the full set of customers in terms of what the interest will be in the segments of customers.

我或許還要補充一點，你的問題──你問題的一部分是關於需求面的。而且我認為，在產品發布的早期階段，你往往會看到早期採用者尋找最新的技術以及所有技術——還有大型機構、大型 IDN。因此，你需要給它一些時間，才能了解所有客戶，以及各個客戶群對哪些產品感興趣。

Again, we'll look for evidence to build over time -- for customers' belief to build over time. And so you probably need some time to see the full set of customers in terms of for the full picture of demand for da Vinci 5 is. And again, that takes some time. Da Vinci 5 is a platform. As we did with Xi, we'll invest in over time. And so you build a set of capabilities also overtime.

我們再次尋找證據，隨著時間的推移，客戶的信任也會逐漸增強。因此，您可能需要一些時間來了解所有客戶，才能全面了解達文西5的需求情況。而且，這也需要一些時間。Da Vinci 5 是一個平台。就像我們當初對習近平所做的那樣，我們會逐步投資。因此，隨著時間的推移，你也會逐步建立一系列能力。

That's helpful. And Jamie, maybe on the gross margin side, very strong and only one-time was 50 basis points was kind of under and the pressure. Maybe initially gross margins would be a little lighter with DV5. Just can you elaborate on the strength and margins this quarter?

那很有幫助。傑米在毛利率方面可能表現非常出色，只有一次低於預期 50 個基點，壓力很大。或許採用 DV5 方案後，初期毛利率會略低一些。您能否詳細說明本季的業績表現和利潤率？

Yeah, I would just say that we described from a sequential basis what drove the improvement quarter on quarter. It was lower inventory reserves. Our teams did an outstanding job with respect to component cost performance with our suppliers and in the logistics area. And that came in earlier than we expected.

是的，我想說的是，我們按季度順序描述了推動季度環比成長的因素。庫存儲備較低。我們的團隊在零件成本控制方面，與供應商的合作以及物流方面都做得非常出色。而且比我們預期的來得更早。

Those are a set of teams that for a couple of years had been working on supply because of COVID and the pandemic. And what happened in terms of supply constraints and those teams in more recent periods have refocused on cost reductions. And we saw that come in early. And so we were really pleased to see that.

由於新冠疫情的影響，這些團隊已經連續幾年致力於供應鏈管理。而最近一段時間，由於供應限制，這些團隊又將重點放在了降低成本。我們看到這種情況很早就出現了。所以我們看到這一點真的很高興。

So great performance in the quarter. You saw us improve the guidance for the year. I would say if we -- as we look at the second half, you will see increased depreciation, as I described. You will see a high proportion of the revenue be new products, da Vinci 5 and Ion and SP.

本季業績非常出色。你們看到了我們改進了今年的指導方針。我想說的是，當我們展望下半年時，你會看到折舊增加，正如我所描述的。你會看到很大一部分收入來自新產品，例如達文西 5、Ion 和 SP。

In Q2, all of the 70 da Vinci 5 placements, only 11 of them were purchase arrangement. So a muted effect in terms of gross margin in the quarter. The other placements are operating leases, where you see the economics play out over time.

第二季度，所有 70 台達文西 5 手術台的安裝中，只有 11 台是購買安排。因此，本季毛利率受到的影響並不顯著。其他租賃方式為經營租賃，你可以看到經濟效益隨時間而顯現。

Great. Thanks a lot.

偉大的。多謝。

Robbie Marcus, JP Morgan.

羅比馬庫斯，摩根大通。

Great. Thanks and I'll add congratulations on a very solid quarter here. I wanted to ask about the feedback in the field. You talked about in the script a bit. We've all talked to doctors and have heard from them. I'd love to hear from you both what the physicians are saying, but also what the institutions are saying.

偉大的。謝謝，我還要祝賀你們本季業績非常出色。我想了解一下來自第一線人員的回饋意見。你在劇本裡稍微提過。我們都和醫生談過了，也聽了他們的意見。我很想聽聽你們兩位醫生們怎麼說，也很想聽聽醫療機構怎麼說。

Clearly, demand is there, 70 units this fast is really strong. But what's the pushback, if any, for centers? How do they feel about the ability to drive better economics and faster procedures and better outcomes with da Vinci 5 and the feedback so far from the physicians?

顯然，市場需求旺盛，這麼快就賣出 70 台，銷量非常強勁。但對於中鋒位置來說，是否有阻力？如果有的話。他們對達文西5號手術系統在提升經濟效益、加速手術流程和改善治療效果的能力有何看法？目前醫生們的回饋如何？

Yeah, Rob, maybe I'll start. This is Dave. Just starting with some of the feedback that we've discussed before, you look at what customers are immediately appreciating and some of the things you would expect around ergonomics, increases in precision and vision, the head in UI, onscreen graphics and other things.

是啊，羅布，也許我會先開始。這是戴夫。首先，我們來看看之前討論過的一些回饋，看看客戶最先欣賞的是什麼，以及他們在人體工學、精度和視覺效果的提升、用戶界面中的頭部、屏幕圖形等方面所期望的一些改進。

And so taken together, each one of those features are leading to some efficiency gains, in particular in console time. And that has been noticed across the customer base. And I think that's where we're starting -- we're hearing a little bit about what can that mean in terms of adding a procedure a day, increasing utilization of the system. And so that's what both our surgeon customers and our executive customers are noticing as a result of their investment in da Vinci 5.

因此，綜合來看，這些特性都能帶來一定的效率提升，尤其是在主機運作時間方面。這一點已經引起了廣大客戶的注意。我認為這就是我們的起點——我們正在了解，每天增加一項手術，提高系統的利用率，這意味著什麼。因此，無論是我們的外科醫生客戶還是我們的高階主管客戶，都因為投資達文西5系統而注意到了這一點。

Some of the other features, Case Insights, Force Feedback, we're excited to work with customers. And we know that's going to take time to develop and really quantify some of those impacts. In terms of pushback, today what we are seeing is a little bit what Jamie talked about.

其他一些功能，例如案例分析、力回饋等，我們很期待與客戶合作。我們知道，要真正量化這些影響，需要時間來研究和評估。就阻力而言，我們今天看到的有點像傑米所說的。

We are starting -- customers will have to evaluate the value of da Vinci 5. We have these early adopters that are excited about what it can be. And as we move in through our measured launch, we will continue to have to underscore, and reinforce the value that it brings, and communicate that to executives and their teams.

我們即將開始—客戶將需要評估達文西5的價值。我們有一些早期用戶，他們對這項技術的未來充滿期待。隨著我們穩步推進產品發布，我們將繼續強調並強化其帶來的價值，並將其傳達給高階主管及其團隊。

I'll just jump in and add a little. We expect to be evaluated against the quadruple or the quintuple aim with regard to DV5. And we are confident that we are going to get there. I think we are going to develop the data to support that perspective. The apples-to-apples price differences aren't that great once you add inflator, and some of the other things that are built in.

我來補充一點。我們期望根據 DV5 的四重或五重目標進行評估。我們有信心能夠實現目標。我認為我們將收集數據來支持這一觀點。加上充氣裝置和其他一些內建功能後，實際價格差異並沒有那麼大。

We have just got to justify that difference. One of the questions I would ask, and Dave, you can answer it is, are there any procedures that physicians prefer using da Vinci 5 Xi to da Vinci 5? In other words, is there any preference to stay with what they have got?

我們必須解釋這種差異的合理性。我會問的一個問題是，戴夫，你可以回答這個問題：醫生們在哪些手術過程中更傾向於使用達文西5 Xi 而不是達文西5？換句話說，他們是否更傾向於維持現狀？

Yeah. So, Gary, in all of my discussions and with the team, surgeons prefer the use of da Vinci 5 for the reasons we talked about.

是的。所以，Gary，在我與團隊的所有討論中，外科醫生都更喜歡使用達文西5號手術系統，原因正如我們之前討論的那樣。

So I think on the administrative side, as long as you can demonstrate that the quadruple aim or the quintuple aim is being satisfied, that they are getting value for the relatively modest apples-to-apples price increase, I think we feel pretty good. I would say on force reflection and on case insights, these are powerful foundational new capabilities that are going into the market. And I think that's really interesting.

所以我認為，從管理方面來說，只要你能證明四重目標或五重目標得到了實現，證明他們從相對適度的同類產品價格上漲中獲得了價值，我認為我們就感覺很好。我認為，在力量反思和案例洞察方面，這些都是即將進入市場的強大的基礎性新功能。我覺得這很有趣。

And we'll work with leading customers to start evaluating where do they make sense and where don't they. We of course believe that there are going to be procedures and patient populations where they make a ton of sense, and they generate real value. So early, it is about data generation and research and feedback. And later, we will start to drive that through clinical publications and other things.

我們將與主要客戶合作，開始評估它們在哪些情況下適用，在哪些情況下不適用。我們當然相信，在某些醫療程序和患者群體中，這些方法非常有意義，並且能夠產生真正的價值。所以目前還處於數據生成、研究和回饋階段。之後，我們將透過臨床出版物和其他方式來推動這一進程。

So I think there is a left hand, right hand here. Some of it is what you get today. You get precision, you get imaging, you get ergonomics, you get throughput. There are some things that in this platform, you get to participate in its research and development. That will come later.

所以我覺得這裡有左手和右手。有些東西是你今天就能得到的。您將獲得精度、成像、人體工學和高吞吐量。在這個平台上，有些東西你可以參與它的研發工作。那以後再說吧。

Then it is a core technology platform upon, which we can build. Jamie mentioned it earlier. So it is that set of sequences that gives us some confidence to keep pushing hard.

那麼它就是一個核心技術平台，我們可以以此為基礎來建構。傑米之前提到過。正是這一系列的進展給了我們繼續努力的信心。

Well Gary, you anticipated my follow-up question. So let me ask another one here. One of the items of feedback I have heard from physicians is that case insights and the force sensing can help existing physicians be better. But more importantly, it could help physicians that do a lot of lab procedures or open procedures make it easier for them to adjust to robotics. Is that something you are hearing? I know it is early in the launch here, but how do you think about those features and the ability to get more conversion from lab to robotic?

加里，你猜對了我的後續問題。那我再問一個問題吧。我從醫生那裡聽到的回饋之一是，病例洞察和力感應可以幫助現有醫生做得更好。但更重要的是，它可以幫助經常進行實驗室操作或開放式手術的醫生更容易適應機器人手術。你聽到的是這樣的聲音嗎？我知道現在還處於產品發布初期，但您如何看待這些功能以及它們在提高實驗室向機器人轉換率方面的作用？

So, I do think there are several ways to consider force feedback and think about it. One of them is, we do think it can have an impact on learning curve. And so as laparoscopic surgeons or newer surgeons to the platform adopted, we believe that force feedback and looking at force feedback through case insights can improve their time to proficiency on the robot.

所以，我認為可以從幾個方面來考慮和思考力回饋。其中一點是，我們認為它可能會對學習曲線產生影響。因此，對於腹腔鏡外科醫生或採用該平台的較新外科醫生而言，我們相信力回饋以及透過病例分析來觀察力回饋可以縮短他們熟練機器人手術的時間。

When it comes to longer term clinical outcomes and what force feedback and the data surrounding it, it's what Gary described. We believe it to be a powerful component of looking to the future and saying, how do we improve surgical outcomes? Does gentler surgery imparting less force on tissue have a difference in outcomes?

就長期臨床結果以及力回饋及其相關數據而言，正如 Gary 所描述的。我們認為這是展望未來並思考「我們如何改善手術效果」的一個重要組成部分？對組織施加較小壓力的溫和手術是否會對結果產生影響？

Our hypothesis is strongly yes. And so that is what is going to take multiple quarters in time to develop. But I do believe there are two segments where force feedback can have that impact.

我們的假設非常肯定。所以，這需要好幾季的時間才能完成開發。但我相信在兩方面，力回饋可以產生這種影響。

Thank you very much.

非常感謝。

David Roman, Goldman Sachs.

大衛羅曼，高盛集團。

Thank you and good afternoon, everybody. I wanted to start on an Ion question. Appreciating some of the supply chain dynamics that may have contributed positively to growth in the quarter. But maybe you could go into a little bit more detail about what you're seeing in the field from an adoption perspective, to what extent you're seeing higher diagnostic yields on Ion result in earlier intervention for patients, and whether those interventions are taking place utilizing da Vinci or not?

謝謝大家，下午好。我想先問一個關於離子的問題。了解一些可能對本季成長做出積極貢獻的供應鏈動態因素。但或許您可以更詳細地介紹一下您在實際應用中看到的情況，例如，Ion 診斷率的提高在多大程度上能夠使患者得到更早的干預，以及這些幹預是否使用了達文西手術系統？

Yes, so with respect to getting a patient into the diagnostic pipeline, that's an independent variable from Ion and or da Vinci. And so that's through screening or incidental findings. But once they're in there, then Ion is offering really, really effective way to go and biopsy that lesion.

是的，所以就讓病人進入診斷流程而言，這是 Ion 或達文西手術系統以外的一個獨立變數。所以，這些都是透過篩檢或偶然發現而獲得的。但是一旦它們進入病灶，Ion 就提供了一種非常有效的活檢方法。

And so, we look at two main variables there. One is the size of the lesion, and then one is the diagnostic yield. And so the important part of this is to diagnose smaller and smaller lesions. Now, the smaller the lesion, it is correlated to cancer stage. And that's where if you get it at stage 1A, you can have very, very high survival.

因此，我們主要關注兩個變數。一是病灶的大小，二是診斷率。因此，這項工作的關鍵在於診斷越來越小的病變。現在，病灶越小，往往與癌症分期有關。如果能在 1A 期確診，就能獲得非常非常高的存活率。

So we're pushing towards smaller lesion size. And then diagnostic yields that are as good as possible, approaching TTNA levels or CT guided biopsy levels, and eventually we hope to exceed those.

所以我們正努力縮小病灶尺寸。然後，我們希望診斷率盡可能高，接近 TTNA 水平或 CT 引導活檢水平，最終我們希望超越這些水平。

And so those together, Ion is proving to be a really effective tool at doing that well, while maintaining an improved safety profile over CT guided needle biopsy. And so, when somebody is diagnosed with Ion and it is deemed to be cancer, then oftentimes they may move to a da Vinci procedure.

因此，綜合以上因素，Ion 已被證明是一種非常有效的工具，能夠很好地完成這項工作，同時保持比 CT 引導針刺活檢更高的安全性。因此，當有人被診斷出患有 Ion 並且被認為是癌症時，他們通常會接受達文西手術。

It's really up to the tumor board and that physician about the best way to treat that patient. It may be with da Vinci; it may be with radiation or some other alternative. So oftentimes they're coupled, but not all the time.

治療該患者的最佳方法，最終取決於腫瘤委員會和主治醫師的決定。可能是透過達文西手術；也可能是透過放射治療或其他替代療法。所以他們經常在一起，但並非總是在一起。

That's a very helpful context. Thank you. And maybe I could ask a financial question on the follow-up here. I think as I look at the operating expense targets for the year, most of the reduction actually looks like, it stems back to what might have been a slower start to the year.

這是一個很有幫助的背景資訊。謝謝。或許我可以就後續事宜問一個財務方面的問題。我認為，從今年的營運費用目標來看，大部分削減實際上似乎都源自於年初可能較為緩慢的成長速度。

I think you grew OpEx about 7% in Q1 and saw an acceleration here in Q2. But maybe you could just help unpack a little bit about -- a little bit of the dynamic underpinning the operating expense growth for the balance of the year. And how we should think about sort of normalized OpEx growth.

我認為你們第一季的營運支出成長了約 7%，並且在第二季看到了加速成長。但或許您可以幫忙稍微分析一下——分析一下支撐今年剩餘時間營運費用成長的動態因素。以及我們應該如何看待正常化的營運支出成長。

Is that the seven number where you started the year, the low double-digit number where you're trending now? And then I don't know if you're willing to offer any perspective on the incremental depreciation, but you were in like the $90 million range in Q1, $100 million range -- in Q1 of this year. Are we talking about a $10 million per quarter increase, $20 million? And any framing you give might be helpful on that side as well?

那是你年初時的數字7，還是你現在正在走的這個兩位數低位數？我不知道您是否願意就增量折舊提供一些看法，但您在今年第一季的增量折舊額大約在 9000 萬美元到 1 億美元之間。我們說的是每季增加 1000 萬美元，還是 2000 萬美元？你提供的任何框架資訊或許對那邊也有幫助？

Yeah. Quarter to quarter, it can be a little lumpy depending on those expenses -- are not consistent across quarters. So I just say if you take the first half, OpEx grew 9%. And you look at the updated guidance, it says the second half grows 11% to 15%, 16%-ish. So an acceleration in the second half.

是的。每個季度的情況可能略有波動，這取決於各項支出——這些支出在各個季度之間並不一致。所以我的意思是，如果只看前半部分，營運支出增加了 9%。你看看更新後的業績指引，上面說下半年成長11%到15%，大概16%左右。所以下半場速度加快了。

From a framing perspective, roughly we're looking to maintain R&D about revenue growth, and it's been at 11% last couple of years. The first half is about 11%. And then you've seen us describe how we've been leveraging enabling functions.

從框架角度來看，我們大致希望維持研發投入以促進營收成長，而過去幾年這一比例一直維持在 11%。前半部約佔 11%。然後，您也看到了我們描述了我們如何利用各種賦能功能。

In terms of then what the OpEx guidance was on the last call versus what it is today, there are some of those lumpy expenses that are no longer in the year just, because of timing. We have looked at some headcount that we had planned for the year that we've pushed into 2025. That's really around focus, not around anything other than focus.

就上次電話會議的營運支出指導與現在的指導相比而言，由於時間安排的原因，一些一次性支出不再計入年內。我們已經檢視了一些原計劃在2025年實施的人員編制計畫。這其實是關乎專注，與專注無關。

Where you see opportunities to continue to leverage maybe at greater rates than we expected, then we'll realize those efficiency benefits. But we do expect second-half operating expenses to be higher than the first half. And that's primarily driven by depreciation. Not ready to be specific about what the relative increase in depreciation expense is, but it is contemplated in that ramp up in second half operating expenses.

如果發現有機會以高於預期的速度繼續利用槓桿作用，那麼我們將實現這些效率提升所帶來的效益。但我們預計下半年的營運費用將高於上半年。這主要是由折舊驅動的。目前還不便具體說明折舊費用的相對成長幅度，但這已包含在下半年營運費用的成長之中。

Great. Thank you very much.

偉大的。非常感謝。

Rick Wise, Stifel.

Rick Wise，Stifel。

Good afternoon, everybody. Hi, Gary. Hi, Dave. Just -- I was hoping that you could talk a little bit more about the procedure growth outlook broadly. You gave us -- you bumped up the range, and we're very clear about the low-end factors at the low and the high end.

大家下午好。嗨，加里。嗨，戴夫。我只是想希望您能更詳細地談談手術增長前景。你提高了我們的選擇範圍，我們對低端和高端產品的低端因素都非常清楚。

But I was just curious, I'm not sure I understand from your perspective. Is our bariatric or GLP-1 pressure is leveling off here? Or have they leveled off? How reasonable is it to think you could get to the upper end? And the same question for the China Asia pressures you talked about as well. Could you just elaborate a little bit on that? Thank you.

但我只是好奇，我不確定我是否能從你的角度理解。我們的減重手術或 GLP-1 壓力是否趨於穩定？或者它們已經趨於穩定了？認為自己能達到頂峰的想法有多合理？同樣的問題也適用於您提到的來自中國和亞洲的壓力。能再詳細解釋一下嗎？謝謝。

Yeah. With regard to how to think about the range, I'm going to ask Brian to step in and do that. So Brian, do that, and then we'll come back to talk a little bit about GLP-1s and I'll perhaps take that. And then I think on China, I'll take it to Dave.

是的。至於如何考慮範圍，我打算請布萊恩來談談。布萊恩，你先去做，然後我們再回來稍微談談 GLP-1，也許我會做那部分。然後我想到中國的問題，我會跟戴夫談談。

So Rick, I'm just going to reemphasize or restate what the range was. So just ramp size 15.5% to 17% is procedure guidance for the year. At the low end, we're assuming that bariatric procedures continue to soften.

里克，我只想再次強調或重申範圍是什麼。所以，今年的施工指導原則是坡道尺寸為 15.5% 至 17%。最保守的估計是，減肥手術的價格會繼續下降。

We did talk a bit about even last quarter and this quarter in Asia around physician strikes that were impacting procedures in Korea along with delayed tenders, impacting procedure or capital placements in China, which, therefore, impacts overall procedures, or procedure growth.

我們確實談到了上個季度和本季亞洲的醫生罷工對韓國手術的影響，以及延遲招標對中國手術或資本配置的影響，因此也影響了整體手術量或手術量成長。

And at the high end of the range, we're really assuming that bariatric essentially stabilizes at current quarter rates. And again, that Korea and China do not get any worse.

在價格區間的高端，我們實際上是假設減肥手術的價格基本上穩定在目前的季度水準。再次強調，韓國和中國的情況不會變得更糟。

Yeah. Speaking of bariatrics, two effects are going on. The GLP-1s are changing to the surgical market. And even within that, there is some share change between laparoscopy and robotics that's going on. So you have two things that are coming through, and they net out. It is not -- the impact of GLP-1s on the bariatric surgery market from our perspective in aggregate has not bottomed yet.

是的。說到減肥手術，它會產生兩種影響。GLP-1受體激動劑正向外科手術市場轉型。即使在腹腔鏡手術和機器人手術之間，也存在著一些份額變化。所以現在有兩個因素在起作用，它們互相抵消了。事實並非如此——從我們的角度來看，GLP-1 對減肥手術市場的整體影響尚未觸底。

And the reality is I don't think anybody knows when and where that will exactly settle for a couple of reasons. I think some of it is looking at the puts and takes of effectiveness. And you have constrained access to the drugs, and you have some new drugs in the pipeline. So that will play out over time. And if somebody told you they knew the answer, I'm not sure I believe them.

而現實情況是，我認為沒有人知道這件事會在何時何地最終塵埃落定，原因有二。我認為其中一些是著眼於有效性的投入和回報。而你們取得藥物的途徑有限，還有一些新藥正在研發中。所以隨著時間的推移，事情會逐漸明朗。如果有人告訴你他們知道答案，我不太相信他們。

Having said all that, we're not depressed about it. I think that it will play out. I think there's a role for bariatric surgery, and I think in our customers' hands with our systems, that surgery has done well. So we're just going to have to all go through it together. I think we're going to look that experience together. With regard to kind of longer-term outlook of procedures in China and overall sentiment. Dave, I'll kick to you.

儘管如此，我們並不為此感到沮喪。我認為事情最終會水落石出。我認為減肥手術有其存在的價值，而且我認為，在我們的客戶使用我們的系統進行手術時，手術效果很好。所以，我們只能一起經歷這一切了。我想我們會一起回顧那段經歷。關於中國程序的長期前景和整體情緒。戴夫，我把球踢給你。

Yeah. What I would say about the longer-term outlook here is our offerings, when I said before, are highly valued in China. The systems are utilized at a high clip. And there's value that surgeons and patients place on high-quality, minimally invasive care. And so that's the draw of this.

是的。關於長期前景，我想說的是，正如我之前所說，我們的產品在中國備受重視。這些系統被高頻使用。外科醫師和患者都非常重視高品質的微創治療。這就是它的吸引力所在。

In terms of some of the headwinds and to me, there are two areas. One is the capital environment that we talked about. And with constrained capital environment and placements, it has an impact on procedure growth.

就一些不利因素而言，我認為有兩個面向。一是我們剛才談到的資本環境。在資本環境和資金投入受限的情況下，這對手術量的成長產生了影響。

And then, there's other areas around this rebasing by the government around economics. And so, it has various impacts. It can have impacts in provinces around charge codes and that is another headwind for us in terms of procedure growth and utilization long term.

此外，政府圍繞經濟進行重新調整還涉及其他領域。因此，它會產生各種影響。這可能會對各省的收費標準產生影響，從長遠來看，這對我們的程序發展和利用率而言是另一個不利因素。

Two comments I'd make on both the headwinds. I think at some point, I'd expect both of them to be time limited. I think there'll be an equilibrium that will be found between GLP-1s and surgery at some point. I also feel like the rebase line in -- the economic rebase line in China and the integration and emergence of domestic systems. But those things will start to find an equilibrium also.

關於這兩個逆風​​，我有兩點看法。我認為在某種程度上，它們都會有時間限制。我認為在某個時候，GLP-1 類藥物和手術之間會找到一種平衡。我也覺得中國的經濟重新基準線以及國內體系的整合與出現，就像是中國的重新基準線。但這些事情最終也會找到一種平衡狀態。

How long is that going to take, is I think what's underlying this question and the answer is we don't know. But I think that minimally invasive surgery in China is highly valued. There's a belief in robotic-assisted surgery as being important. And our products and ecosystem is valued. So I think that we're enthusiastic about completing that.

我認為這個問題背後的根本問題是：這需要多長時間？而答案是我們不知道。但我認為，微創手術在中國備受重視。人們普遍認為機器人輔助手術非常重要。我們的產品和生態系統都備受重視。所以我覺得我們很樂意完成這項工作。

Yeah. Gary, if I could just one follow-up. The question I have gotten most frequently post the launch of DV5 is what new procedure -- what new incremental TAM will da Vinci 5 unlock? I had the privilege of interviewing Dave, who might be near at hand today, that question at SRS. And I said the way da Vinci 5 unlock the general surgery TAM, what will da Vinci 5 unlock, and Dave very eloquently said it's going to unlock the routine use of robotic surgery every day.

是的。加里，如果我可以再問一個問題的話。DV5 發布後，我被問到最多的問題是：達文西 5 將解鎖哪些新程式——哪些新的增量 TAM？我有幸採訪了戴夫，他今天可能就在附近，就這個問題向他提出了 SRS 的問題。我問，達文西 5 解鎖了普通外科手術的 TAM，那麼達文西 5 會解鎖什麼？戴夫非常雄辯地表示，它將解鎖機器人手術的日常常規應用。

Do you agree with Dave? And is that -- are your customers understanding that vision or getting that that's what you're aiming at just any reaction to those thoughts, I'd appreciate it? Thank you, Dave.

你同意戴夫的觀點嗎？那麼，您的客戶是否了解這個願景，或者是否明白這就是您的目標？如果您能就這些想法發表任何評論，我將不勝感激。謝謝你，戴夫。

You're welcome, Rick.

不客氣，里克。

Yeah. I'll start. Good you asked. Yeah, I agree with him. No shock. Maybe just to reiterate our position. There's two different ways that it can help grow long-term. One way is to go deeper into the procedure base, we're in already to help care teams and physicians who have thus far not wanted to adopt or have chosen not to adopt, or have had a barrier to adoption, to help them adopt.

是的。我先來。問得好。是的，我同意他的看法。毫不意外。或許只是想重申我們的立場。它可以透過兩種不同的方式幫助實現長期成長。一種方法是深入到程序基礎中，我們已經進入這個領域，幫助那些迄今為止不想採用或選擇不採用，或採用存在障礙的護理團隊和醫生，幫助他們採用。

And that can be through some of the functionality of DV5 and what it does, a little bit of easier access to other capital for example, of Xis become more used in more places. It can release access constraints together as a portfolio. Those are powerful things, and that speaks to what Dave spoke about.

這可以透過 DV5 的一些功能及其作用來實現，例如，更容易獲得其他資本，或讓 Xi 在更多地方得到更廣泛的應用。它可以作為一個整體釋放存取限制。這些都是很有力量的東西，這也印證了戴夫所說的。

We don't think we're done getting additional indications on DV5. And those are things that could happen in the future. And as we get closer and see what those opportunities are, we'll describe them.

我們認為關於DV5的更多跡象還沒有完全顯現。這些都是未來可能會發生的事。隨著我們越來越接近目標，看到這些機會是什麼，我們會進行描述。

Thank you.

謝謝。

Drew Ranieri, Morgan Stanley.

德魯‧拉涅利，摩根士丹利。

Hi, thanks for taking the questions. Maybe just something that we also heard from SRS was that the DV -- da Vinci Xi is still very well considered in the field and there are surgeons that still want to get their hands on it. So just can you talk a little bit more about some of the underlying demand for Xi in the US?

您好，感謝您回答這些問題。或許我們也從 SRS 那裡聽到的是，達文西 Xi 手術系統在該領域仍然備受推崇，並且還有一些外科醫生仍然想要使用它。那麼，您能否再詳細談談美國民眾對習近平的潛在需求？

And Jamie, I think you pointed out too, that you kind of expect DV5 to sequentially improve throughout the year. So maybe just talk to us about what that means for Xi, given that you're having broader conversations with hospital administrators and surgeons as they're thinking about building capacity for robotic surgery?

傑米，我想你也指出了這一點，你預計 DV5 將在一年內逐步提高。鑑於您正在與醫院管理人員和外科醫生進行更廣泛的對話，探討如何提高機器人手術能力，那麼或許您可以和我們談談這對習來說意味著什麼？

Yeah. I would just say in the US, demand for Xi kind of has two segments to it. You have customers that need incremental capacity. Da Vinci 5 isn't available in the time that they need it. And so they're entering into arrangements with us to take Xi now to serve that expansion of capacity they need.

是的。我想說的是，在美國，習近平的需求大致可以分成兩個部分。您有客戶需要增加產能。他們需要的達文西5軟體無法及時提供。因此，他們正在與我們達成協議，接收 Xi 來滿足他們所需的產能擴張。

And then they have the upgrade right built into the arrangement to move to da Vinci 5 when it becomes available likely in broad launch. You have another segment of customers in the US who are kind of wait and see with respect to, what the value will be of da Vinci 5. And again, they look for building evidence and a broadening of customer belief.

然後，他們已經將升級方案納入其中，以便在 da Vinci 5 廣泛發佈時進行升級。在美國，還有一部分客戶正在觀望達文西5的價值究竟如何。他們再次尋求證據，並希望擴大客戶的信任。

And part of that consideration is the profile of that customer, what their strategy is, what their procedure mix is. And of course, as part of the consideration, they're looking at the incremental price, which as Gary described, when you do the full stack isn't actually that significant.

而這其中一部分考慮因素是客戶的特徵，他們的策略是什麼，他們的流程組合是什麼。當然，作為考慮因素之一，他們也在考慮增量價格，正如 Gary 所描述的那樣，當你使用全套設備時，增量價格實際上並沒有那麼重要。

But those customers that have tight capital budgets who like Xi, which is a capable system are more a wait and see. So I think in terms of -- as you look forward, that will evolve with respect to how da Vinci capacity expands, and the extent to which then more customers can take that system. But there is a segment of customers that really like Xi.

但對於那些資金預算緊張，又喜歡 Xi（一款功能強大的系統）的客戶來說，他們更傾向於觀望。所以我認為，展望未來，隨著達文西手術能力的擴大，以及更多客戶能夠使用系統的程度，這種情況將會改變。但確實有一部分顧客非常喜歡 Xi。

And has there been any change in thinking about bringing da Vinci 5, to the broader global markets, I know that you're working on a couple of regulatory filings right now, but any update on timing or further market expansion? Thanks for taking the questions.

關於將達文西5推向更廣泛的全球市場，你們的想法是否有所改變？我知道你們目前正在準備一些監管文件，但關於時間安排或進一步的市場擴張，有什麼最新消息嗎？謝謝您回答問題。

Yeah. Just in terms of our OUS plans, I think it's consistent with what we have communicated, which is -- we're in discussions with Korea and Japan and don't expect to launch in Europe, before the end of next year. And so as we look beyond that, it's just too early to detail out those plans, and we'll let you know as they get a little bit more into focus here.

是的。就我們的海外市場計劃而言，我認為這與我們已傳達的訊息一致，即——我們正在與韓國和日本進行討論，預計在明年年底之前不會在歐洲推出。因此，展望未來，現在詳細闡述這些計劃還為時過早，一旦計劃更加清晰，我們會及時通知大家。

Adam Maeder, Piper Sandler.

亞當梅德，派珀桑德勒。

Hi. Good afternoon. Thank you for taking the questions and congrats on the nice quarter. Two from me. The first one is on DV5, and I specifically wanted to ask about the hardware and software changes that you plan to make, in the back half of the year.

你好。午安.感謝您回答問題，並祝賀您本季業績出色。我投兩票。第一個問題是關於 DV5 的，我特別想問您計劃在今年下半年進行哪些硬體和軟體方面的更改。

What are you hoping to improve upon? What is the magnitude of the changes that you plan to implement? It sounds like they're relatively minor but wanted to confirm that. And then I had a follow-up? Thank you.

您希望在哪些方面進行改進？您計畫實施的變革規模有多大？聽起來像是比較輕微的事件，但還是想確認一下。然後我還有後續問題？謝謝。

Sure. I'll take that. So some of the near-term additions that we're talking about include the integration of hub capabilities of Intuitive Hub. And then from the surgeon having this head-end experience, when they're in the console, they'll be able to start accessing and controlling Intuitive 3D models, being able to manipulate them from the console with the controls there.

當然。我接受。因此，我們正在討論的一些近期新增功能包括整合 Intuitive Hub 的中心樞紐功能。然後，外科醫生透過這種前端體驗，當他們在控制台中時，他們將能夠開始存取和控制直覺的 3D 模型，並能夠透過控制台上的控制項來操作它們。

And also, they'll have the ability to access and replay intraoperative video. And then we'll also include and integrate in simulation. So that gives you a flavor, I think, of some of the pieces that we're adding that we've talked about in these hardware and software upgrades.

此外，他們還可以存取和回放術中影片。然後我們也會將其納入仿真中並進行整合。我想，這應該能讓您對我們在硬體和軟體升級中提到的一些新增功能有所了解。

In addition, there will be some software upgrades that include responding to customer feedback as well. And some of the things that we've heard as we're going through our measured launch here.

此外，我們也會進行一些軟體升級，其中也包括對客戶回饋的回應。在我們穩定地推動產品上市的過程中，我們也聽到了一些回饋。

And then if you look a little further out, some intraoperative technology building blocks that we're working on, such as procedure step mapping, and 3D depth mapping that will use some AI and ML algorithms and leverage this compute power of da Vinci 5. And those things will set us up for some more advanced features in the future that leverage that foundation.

然後，如果你再往前看一點，你會發現我們正在研究一些術中技術建立模組，例如手術步驟映射和 3D 深度映射，這些模組將使用一些人工智慧和機器學習演算法，並利用達文西 5 的運算能力。這些都將為我們未來開發一些更進階的功能奠定基礎。

Highly good color, Dave. Thank you for that and for the follow-up. Wanted to ask about SP. Congrats on the thoracic indication. I'm curious how much you think that expands the opportunity for SP here in the states. I know you're also working on cold erectile, so curious if you have timelines there? And then together, does that kind of give you the indication base to push SP more aggressively in the US? Thanks for taking the questions.

戴夫，顏色真棒。謝謝你的回覆和後續跟進。想問一下SP的狀況。恭喜您獲得胸腔外科手術指徵。我很想知道你認為這會在多大程度上擴大SP在美國的機會。我知道你也在研究冷性勃起功能障礙，所以很好奇你那方面的進度安排？那麼，綜合來看，這是否意味著應該更積極地在美國推廣SP股票？謝謝您回答問題。

Yeah. In terms of thoracic, in the early period, that procedure actually is optimal when you have a stapler and we're in development for a stapler for SP. And so, we'll be able to work with early adopters on the thoracic indication. But it's really when the stapler comes that you're able to more robustly drive adoption. One of the advantages of SP is, of course then the opportunity to access the body in ways that, does less damage to healthy tissue.

是的。就胸腔外科而言，在早期階段，使用吻合器進行手術實際上是最佳選擇，而我們正在開發 SP 的吻合器。因此，我們將能夠與早期採用者合作，共同探索胸腔適應症。但只有當訂書機出現時，才能真正有效地推動產品的普及。SP 的優點之一當然是能夠以對健康組織損害較小的方式進入人體。

Today in the US, in terms of thoracic for multiple, we're already relatively highly penetrated. And so really the question then is relative value of SP compared to Xi. What was the second part of your question? I'm sorry, if you could repeat it?

如今在美國，就多發性胸腔疾病而言，我們的滲透率已經相對較高。所以真正的問題是SP相對於Xi的相對值。你問題的第二部分是什麼？不好意思，您能再說一次嗎？

Yes, happy to. I was just asking about colorectal timing. I think you have the IDE study that's ongoing. And I think that will be your fourth indication once the colorectal indication is in hand. So does that kind of give you critical mass from an indication standpoint to push more aggressively with SP in the US?

是的，我很樂意。我只是在問大腸桿菌檢測的時間。我認為你正在進行IDE研究。我認為，一旦大腸癌適應症得到批准，這將是你的第四個適應症。那麼，從指標的角度來看，這是否足以讓你在美國更積極推動SP的上市？

Yeah. The work on the IDE has progressed. We don't have any additional detail at this point. And obviously, that then adds another category with respect to the set of indications in the US. And I think it does have -- give us the opportunity to both supplement SP procedure growth in the US.

是的。IDE的開發工作已經取得進展。目前我們還沒有更多細節。顯然，這又為美國的適應症集合增加了一個新的類別。我認為這確實給了我們一個機會，既可以補充美國 SP 手術的成長。

And add to the growing utilization we see of the SP platform in the US, but I think we also have the opportunity for additional indications over time in the US. Colorectal like thoracic will also require the SP stapler.

此外，我們看到 SP 平台在美國的使用率不斷提高，但我認為隨著時間的推移，我們也有機會在美國獲得更多適應症。大腸直腸手術和胸腔外科手術一樣，也需要使用 SP 吻合器。

Operator, we'll take one more question from one more call and then we'll wrap.

接線員，我們再接聽一通電話，回答最後一個問題，然後就結束通話。

Richard Newitter, Truist Securities.

Richard Newitter，Truist Securities。

Thanks for taking the question. Maybe for Jamie, just Jamie in the past, you've talked about a long-term or an intermediate to long-term three, four-year time frame to get back above sustainably 70% gross margin. A, correct me if that's not true, but I'm pretty sure that's what you've said in the past.

感謝您回答這個問題。也許對 Jamie 來說，就 Jamie 而言，過去你曾談到過，需要三到四年的中長期或中長期時間框架才能使毛利率恢復到可持續的 70% 以上。A，如果我說錯了請糾正我，但我很確定你以前說過這樣的話。

I'm just curious just with some of the initiatives maybe paying dividends earlier than expected and faster. I know you have some manufacturing transition going on for Ion disposables. That's a big initiative. Is it possible we're moving towards that goal a little faster sooner? I'd love to hear any thoughts there.

我只是好奇，有些措施或許能比預期更早、更快產生效益。我知道你們的 Ion 一次性醫療器材正在進行一些生產轉型。那是一項意義重大的舉措。我們是否有可能更快地朝著這個目標邁進？我很想聽聽大家的想法。

Specifically, 70% gross margin, that's not sustainable in the shorter term. It continues to be our aspiration to have gross margin at 70% in the medium term. There's work for us to do over that period with respect to obviously da Vince costs.

具體來說，70%的毛利率在短期內是不可持續的。我們仍然希望在中期內實現70%的毛利率。在那段時間裡，我們顯然需要處理達文斯（Da Vince）的費用問題。

We have to continue to progress on Ion and SP costs. And as we've said, we have incremental depreciation in the second half and more significant incremental depreciation next year. And so that will also require us to then manufacturing capacity related, which you build in chunks.

我們必須繼續推進離子和SP成本的工作。正如我們所說，下半年會有少量折舊，明年會有更多少量折舊。因此，這也需要我們逐步建立相關的生產能力。

We'll have to revenue leverage that incremental depreciation over a period of time. Certainly, in terms of the baseline of where we are at, the cost reductions we described on component costs, and logistic costs have come in a little earlier. And that's why we've raised the guidance, for gross margin for this year. But the aspiration for 70% gross margin is still a medium-term aspiration.

我們需要利用這部分增量折舊在一段時間內轉化為收入。當然，就我們目前的基準而言，我們之前提到的零件成本和物流成本的降低已經提前一些實現了。因此，我們提高了今年的毛利率預期。但實現 70% 的毛利率仍然是一個中期目標。

I'll wrap it there. Thank you. That was our last question. In closing, we believe that there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians, and care teams in pursuit of what our customers have now termed the quintupling, better -- more predictable patient outcomes, better experiences for patients, better experiences for their care teams, better access to great care and ultimately, a lower total cost of care.

我就把它包在那裡。謝謝。這是我們最後一個問題。最後，我們認為，從根本上改善外科手術和急診幹預措施存在著巨大而持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，追求客戶現在所說的「五倍提升」——更可預測的患者治療結果、更好的患者體驗、更好的護理團隊體驗、更容易獲得優質護理，並最終降低總護理成本。

We believe value creation in surgery and acute care is foundationally human. It flows from respect for and understanding of patients and care teams, their needs and their environment. At Intuitive, we envision the future of care that is less invasive and profoundly better where diseases are identified earlier and treated quickly so patients can get back to what matters most. Thank you for your support on this extraordinary journey. We look forward to talking to you again in three months.

我們認為，外科手術和急診護理中的價值創造本質上是人性的。它源自於對病人和照護團隊、他們的需求以及他們所處環境的尊重和理解。在 Intuitive，我們展望未來，希望醫療照護更加微創、效果顯著，能夠更早發現疾病並迅速治療，讓患者能夠重返最重要的生活。感謝您在這段非凡旅程中給予的支持。我們期待三個月後再次與您聯繫。

Thank you, everyone, for joining today's conference call. You may now disconnect at this time. Have a good day.

感謝各位參加今天的電話會議。您現在可以斷開連線了。祝你有美好的一天。